Tandem Gait Test Shows Moderate-to-Good Correlation with Cervical Myelopathy Severity
The tandem gait test demonstrates clinically useful correlation with cervical myelopathy severity, with correlation coefficients of r=0.553 for JOA scores and r=-0.652 for Nurick scale, making it a valuable objective screening tool for gait disturbance in degenerative cervical myelopathy (DCM). 1
Strength of Correlation
The 10-step tandem gait test shows statistically significant associations with established myelopathy severity measures:
- JOA sub-score correlation: r = 0.553 (p < 0.001) - indicating moderate positive correlation
- Nurick scale correlation: r = -0.652 (p < 0.001) - indicating good negative correlation (higher Nurick = worse function)
- DCM patients completed significantly fewer consecutive steps compared to controls (7.1 ± 3.6 vs 9.9 ± 0.4 steps, p < 0.001) 1
The test also correlates with quantitative gait parameters including slower velocity, shorter strides, wider bases, and increased stance phase duration 1.
Diagnostic Performance
In a prospective diagnostic accuracy study, tandem gait assessment demonstrated:
- Youden's Index of 40% (sensitivity + specificity - 1), which is modest but clinically useful 2
- This places it below other physical exam findings like upper extremity reflexes (YI=54%) and manual motor testing (YI=53%), but still provides objective value 2
Clinical Context and Recommendations
Gait analysis, including tandem gait testing, is recommended as a valid and reliable functional outcome measure for assessing patients with cervical spondylotic myelopathy (Class II evidence, Grade B recommendation) 3. This guideline-level recommendation supports its routine clinical use.
Practical Application
The 10-step protocol provides a standardized approach:
- Grade patients 0-5 based on number of consecutive steps and stability
- DCM patients show distinctly different grade distributions compared to controls 1
- The test captures gait impairment that reflects underlying spinal cord dysfunction
Important Caveats
- Tandem gait is not specific to cervical myelopathy - abnormalities occur in cerebellar disease, vestibular disorders, peripheral neuropathies, and parkinsonism 4
- Must be interpreted alongside other clinical findings, imaging, and disease-specific measures
- No standardized, guideline-based protocol exists across all neurological conditions, though the 10-step version has been validated specifically for DCM 4
- Better diagnostic utility comes from combining tandem gait with other assessments like upper extremity reflexes, manual motor testing, and patient-reported measures (mJOA, NDI) 2
The tandem gait test serves as an objective, quantifiable screening tool that correlates moderately-to-well with myelopathy severity, making it useful for both diagnosis and monitoring disease progression in DCM patients.